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SD cases fulfill at least one of three criteria: (1) severe plasma leakage: associated with shock (tachycardia >100 or narrow pulse pressure <20 or blood pressure <90 mmHg) or respiratory distress, (2) severe hemorrhage: gastrointestinal tract bleeding such as haemetemesis or melaena or bleeding per rectum, pack cell transfusion or blood transfusion requirement or menorrhagia (3) severe organ impairment: defined as aspartate or alanine transaminase ≥1000units/l, acute renal impairment (creatinine ×2 upper limit of normal for age and sex (based on modification of diet in renal disease equation for Glomerular filtration rate = 75 ml/min) or baseline estimated from minimum creatinine recorded), encephalopathy and myocarditis [14].
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